Tissue Density Restoration (TDR) massage is based upon my theory that every pain in the musculoskeletal system is closely associated with an elevation of tissue density (TD). This is significant because by restoring the tissues to a more normal density, the pain is resolved as well. In addition, by measuring, grading, and recording the density of the involved tissue, one may develop an accurate, objective assessment of the condition of tissues before, during, and after treatment. (See "The Tissue Density Grading Scale: A Communication Tool," Massage Today, March, 2014.) Grading TD is useful for communicating with the client and other health care professionals, and it can help to determine the effectiveness of specific treatment modalities. Through observation over time, I have found the most effective and repeatable results come from utilizing the following principles.

First Principle

Work on the area that is in the most pain first. Pain relief will be your client's most immediate concern, as well as improved mobility, which usually coincides with a reduction in pain.

Second Principle

Provide gentle heat with the intention of elevating the temperature of the target tissues. Heat softens the tissues. Stecco, C. (2015) states: "It is demonstrated that when the temperature is increased to over 40 degrees C [104 degrees F], the three-dimensional superstructure of HA (Hyaluronic Acid) chains, via inter- and intramolecular water bridges (van der Waal's and hydrophobic forces), breakdown progressively. This decreases HA viscosity of the loose connective tissue that is present within and beneath deep fasciae and muscles (pg. 64, fig 3.3)."

The decreased viscosity results in a softening of the tissues. The author goes on to inform that the effect of the elevated temperature is only temporary, and surmises that immobilization during a night's sleep causes the elevated viscosity of HA by the morning, resulting in stiffness of tissues. She concludes that, "If the alteration of the viscosity is slight just a minimal increase in temperature would be enough to restore normal function of the fasciae." It is my hope that one day researchers will look into the effects of sustained application of heat and movement in the manner I have described.

Third Principle

Keep the target area moving. Movement creates friction, which helps increase the temperature of the target tissues, and movement helps flush the localized area with nutrients and moisture. Lack of adequate hydration causes tissues to lose their elasticity, shrink, and harden.

Fourth Principle

Generally, just work on an area about the span of your two hands in size. In order to generate an adequate amount of heat and movement within the area that hurts, you will want to focus directly on the palpable area of elevated TD. If the area you are working on becomes too large, the temperature will not get warm enough.

Fifth Principle

Work on each target area for at least 45 minutes. In case after case in my clinical practice, I have found that constant warmth and movement, sustained over a period of at least 45 minutes will result in significant softening of elevated TD, pain relief, and improvement of mobility. I believe that the reason massage is viewed as a temporary "feel-good" measure by many, rather than a more lasting treatment, is because enough heat has not been applied for a long enough period of time to be able to make an actual change in TD.

Sixth Principle

It is important that the receiver of TDR massage is adequately hydrated. Our bodies need adequate hydration to function properly. One can talk to their clients about providing their bodies with enough water to maintain the cushioning their joints and tissues need without stepping over the boundary of prescribing, or being accused of disseminating junk science. I've had many new clients state that they only drink a liter of water a day, and some less than that. I think it is reasonable to believe that hypo-hydration plays a part in chronic pain scenarios.

Seventh Principle

Never go over a 3 on the 1/10 Pain scale, and use that rating to determine the amount of pressure to apply throughout the treatment. There is no good reason to cause pain. By doing so, the client will be uncomfortable and guarded. According to Shubayev, et al, "Tissue injury produces an inflammatory environment that can be modeled as an "inflammatory soup" of chemicals that are in part regulated by cytokines, and that cause spontaneous neurophysiological activity that activates nociceptive pathways (2010, fig. 8.1)." It would be best to avoid initiating that activation.

Keeping these principles in mind, provide focused massage with the purpose of softening and smoothing away dense, hardened, painful tissues using petrissage, kneading, and circular motions. As you move the tissues, as much and as deeply as possible without causing pain, you will feel a sensation of the elevated TD "melting away." You will find that the more malleable it becomes, the deeper you can work, and the better your results will be.

References

1. 1. Stecco, C., (2015). Functional Atlas of the Human Fascial System. Edinburgh: Churchill Livingstone Elsevier.
2. 2. Shubayev, V.I., Kato, K., & Myers, R.R. (2010). Cytokines in pain. In, Translational pain research: From mouse to man. (fig. 8.1) Boca Raton, FL: CRC Press.
3. 3. LePelley, L., (2014, March). The Tissue Density Grading Scale: A Communication Tool. Massage Today, 2014.